Barber - Sole Proprietor/Partnership Shop Owner Original Permit

Proof of Zoning Documentation Attestation:

Official documentation, demonstrating the approved zoned use of your shop's address, must be obtained from your county's local zoning board, prior to completing this application. The documentation MUST state the approved zoned use for a cosmetology or barber related business. Your application WILL NOT be processed without providing the required zoning documentation. You must submit your documentation within 10 days of completing this application.
Does your documentation specifically state the zoned use for a cosmetology or barber related business? (Ex: HAIR SALON, NAIL SALON, SPA, BARBER SHOP, PERSONAL SERVICES) Yes
Does your documentation state the exact address of your business? Yes

Document Delivery Instructions:

For the most efficient service, your documentation should be emailed, including the business's name, owner's name & owner's phone number.

Please send Proof of Zoning documentation by email as our preferred method. However, if you prefer to send the documentation by postal mail, you may use the mailing address as listed below.

Email Address to send documentation: barbers.cos@maryland.gov ** PREFERRED **

- OR -
Mail documentation to address below:
Board of Barbers
1100 N. Eutaw Street, Room 121
Baltimore, MD 21201

Check the box below to acknowledge that you must send your documentation within 10 days after the submission of your application.

– I acknowledge that I will be sending my documentation within 10 days after my submission.

Personal Information:

Enter business type: Sole Proprietor or Partnership

Sole Proprietor or Partner #1 Name:	First	Middle
	Last

Partner #2 Name:	First	Middle
	Last

The following personal information should be for the sole proprietor or partner #1:

	I have a United States mailing address
	Address:
	City, State Zip:	, -
	County:
	I have a mailing address outside the United States
	Address:

Social Security Number:

Date of Birth (MM-DD-YYYY):

- -

Place of Birth:

	I was born in the United States
	City and State: ,
	I was born outside the United States
	City and Country:

Gender: Male Female

Home Phone Number:	- -
E-mail Address:

Business Information:

Note: If you change the name of your shop, the outside signage of the business must be changed to match the shop's name. If the names do not match, you are in violation of the Barber Regulations. If the address below is no longer valid , please exit this application and apply for an original salon/shop permit.

Shop Name/Outside Signage:
Shop Address:
City, State Zip:	, -
County of Shop Address:
Business Phone No.:	- -

Required Information:

Have you ever:

1.	Been convicted of a felony or misdemeanor in any State or Federal Court?	Yes	No
2.	Had this type of license, certificate, registration, or permit denied, suspended, or revoked by Maryland or any other jurisdiction?	Yes	No

Workers Compensation:

I have Workers Compensation Coverage Policy/Binder No.

Issued by the

I am not an employer required to provide employee coverage under the Workers Compensation Law.

Certification:

By pressing "Submit" below:

I hereby certify, under penalty of perjury, that the information contained herein is true and correct to the best of my knowledge, information, and belief. I further authorize the release of any information contained within this application to an authorized representative of the Department of Labor for further investigation. I further certify that I have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Department of Labor or have provided for payment in a manner satisfactory to the unit responsible for collection.

In accordance with Executive Order 01.901.1983-18, the Department of Labor is required to advise you as follows regarding the collecting of personal information: Personal information requested by the licensing agency of the Department is necessary in determining your eligibility for licensure. Such personal information is also intended for use as an additional means of verifying the permitee’s identity or to enable the agency to communicate, in a timely manner, with the permit holder should the need arise. The permit holder has a right to inspect his/her personal record and to amend or correct the personal data if necessary. Personal information is generally available for inspection by the public only in accordance with the Public Information Act. Personal information is not routinely shared with state, federal or local government agencies.

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